The mind is one of the most fascinating, complex aspects of our human identity. While it is widely considered separate from the physical structure of the brain, it is understood that there is a strong relationship between the inner workings of the mind and brain-body function. We use our minds to experience and process emotions, memories, thoughts, and decisions, which ultimately determines our behavior and can affect the delicate physical and chemical balance that provides our bodies with physiological health. These unique capabilities are what have allowed humanity to evolve intellectually, creatively, and socially over thousands of years.
With such complex mental faculties, the field of dentistry has advanced leaps and bounds in its knowledge of the oral cavity, its relationship to the body as a complete system, as well as technology we utilize to treat dental disease—all thanks to the brilliance of the human mind. In our daily roles as dental professionals, our mental abilities are what allow us to evaluate our patients’ oral conditions, make important decisions in proper diagnosis and treatment, and form a personal connection with the person being cared for. So, what happens if this mental component goes awry for the clinician? More specifically, is mental health a concern for dental professionals?
While this statement serves as a basic description of what it means to be mentally healthy in the general sense, we know that circumstances in life are subject to constant change. Physical health, relationships, working conditions, and basic needs can shift over time, requiring a person to periodically adjust his or her way of coping to maintain mental well-being.
For this reason, it has been suggested that a more comprehensive definition be used for mental health:
A dynamic state of internal equilibrium which enables individuals to use their abilities in harmony with universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one’s own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium.2
Simply put, life has a way of presenting us with a variety of good and bad experiences at a steady pace, and our ability to keep a balanced outlook will determine our mental health.
Now that we have a basic understanding of what it means to have mental health, it is helpful to know some of the stressors that can negatively impact that internal equilibrium we need to live happy, fulfilled lives. In the health-care industry, burnout syndrome is a common threat to providers’ mental health and is usually associated with challenging, demanding work in combination with a lack of time, appropriate resources, and support from leadership.3 When looking at the dental profession exclusively, it has been determined that things such as long working hours, not enough time with family, low office morale, salary, the pressure of a heavy workload, and problems at home can contribute to an individual’s struggles with his or her mental health.4 As if managing these day-to-day worries isn’t enough for dental professionals, a global health crisis has complicated things that much more. Recent concerns over the potential of exposure to COVID-19-positive patients, difficulty obtaining necessary personal protective equipment, and keeping up with emergency protocols have caused an increase in anxiety and depression among clinicians.5 It’s fair to say that circumstances in our field can absolutely have an impact on mental health.
It can be difficult to identify mental health problems. We are trained to identify oral pathology by clinical presentation, the presence or absence of pain, diagnostic testing, and the patient’s own historical account. Unlike the mouth, however, the mind is nonphysical, and illness does not typically present itself as painful or visible. Further, there are very few options available for reliable diagnostic testing. Instead, detection of signs related to mental illness are most often seen externally by others as behavioral changes or experienced internally by the affected person in the way he or she thinks and feels.
Early signs of mental illness can include:6,7
- Feeling deeply sad, anxious, angry, or apathetic
- Loss of energy
- Extreme worrying or fear
- Mental fog or confusion
- Social withdrawal
- Sleeping too much or too little
- Increased or decreased appetite
- Feeling worthless or carrying unnecessary guilt
- Thinking about death
Over time, these symptoms may increase in severity and frequency depending upon the individual. In advanced cases, affected individuals may feel intensely depressed and overwhelmed, losing their ability to function in day-to-day life. They may behave out of character, resort to drug or alcohol use, and seriously consider suicide.8 These are intense feelings for anyone to bear, but—for dental professionals specifically—dealing with ongoing, unmanaged mental illness can have a negative impact on their ability to support the team and provide quality care to patients.
While the burden of mental illness has the potential to devastate the career and overall well-being of the affected clinician, the good news is that there is hope! Many solutions and treatment options are available to anyone who may be experiencing a mental health crisis, and there is no shame in seeking help. Like any other part of the body, the mind is not immune to illness, and special care must be taken when a threat is identified. Despite any stigmas associated with it, the truth is that close to half of all US adults will experience mental illness to some degree during their lives.9 Thanks to increased efforts in raising awareness and education for mental health over the years, it has become a much more commonly recognized and respected cause.
What actions can you take if you suspect mental illness in a dental professional?
If concerns arise with a fellow team member, the best starting point is to approach the person with your observations, create a safe place for him or her to share what they’re experiencing with complete privacy, make sure to actively listen without judgment or interruption, provide encouragement, and help direct the person toward the help he or she needs.10 If you are experiencing mental health issues personally, finding a trustworthy person to talk to is of utmost importance.
Once this confidential connection has been established and concerns have been communicated, the next step is to seek specialized support. Just like our patients cannot properly treat their own tooth abscesses, we must remember that mental illness requires help from a trained professional.
Therapists, counselors, psychologists, primary care physicians, psychiatrists, and pastoral counselors are all equipped to assist in managing mental illness. Depending on the type of professional, treatment options might include making lifestyle changes to reduce stress and emotional triggers, counseling to work through past experiences or traumas, and/or medication to achieve a healthier chemical balance in the brain.11 Finding the ideal patient-provider partnership may require continued research or more than one professional consultation, but it’s important to remain steadfast and hopeful. Once interventions are made, the road to mental wellness can begin and a positive outlook can be restored. One experiences great relief when the heavy weight of mental affliction is lifted.
No matter the role you have in the dental community, your educational background, or stage in life—one thing we all have in common is a fundamental need for mental wellness. We are gifted with intelligent, imaginative, individually unique minds that allow us to connect with one another and impact our world in profound ways. As complex and wonderful as they are, our minds require constant care and cannot be neglected when the threat to optimal health exists. Mental illness is as real as it is common, but thankfully there are many options available to receive help. A human with a healthy mind and a passion for dentistry is a beautiful thing. Best wishes!
Editor's note: This article appeared in the September 2021 print edition of RDH magazine.
For more information on mental health and how to find assistance, please visit these resources:
- National Suicide Prevention Hotline: (800) 273-8255
- Dental Mental Network: https://dentalmentalnetwork.com
- National Alliance on Mental Health: https://www.nami.org
- National Council for Mental Wellbeing: https://www.thenationalcouncil.org
- Promoting mental health: concepts, emerging evidence, practice (Summary Report) Geneva: World Health Organization; 2004.
- Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. Toward a new definition of mental health. World Psychiatry. 2015;14(2):231-233. doi:10.1002/wps.20231
- Bridgeman PJ, Bridgeman MB, Barone J. Burnout syndrome among healthcare professionals. Am J Health Syst Pharm. 2018;75(3):147-152. doi:10.2146/ajhp170460
- Mishra S, Singh S, Tiwari V, Vanza B, Khare N, Bharadwaj P. Assessment of level of perceived stress and sources of stress among dental professionals before and during the COVID-19 outbreak. J Int Soc Prev Community Dent. 2020;10(6):794-802. doi:10.4103/jispcd.JISPCD_340_20
- Estrich CG, Gurenlian JR, Battrell A, et al. COVID-19 prevalence and related practices among dental hygienists in the United States. J Dent Hyg. 2021;95(1):6-16.
- Warning signs and symptoms. National Alliance on Mental Illness. Accessed June 5, 2021. https://www.nami.org/About-Mental-Illness/Warning-Signs-and-Symptoms
- Mental Health First Aid USA. What to look for: signs and symptoms of depression. National Council for Mental Wellbeing. October 8, 2019. Accessed June 5, 2021. https://www.mentalhealthfirstaid.org/2019/10/what-to-look-for-signs-and-symptoms-of-depression/
- Novacek J, Raskin R. Recognition of warning signs: a consideration for cost-effective treatment of severe mental illness. 1998;49(3):376-378. doi:10.1176/ps.49.3.376
- How mental health first aid can help reduce stigma. National Council for Mental Wellbeing. June 3, 2021. Accessed June 5, 2021. https://www.mentalhealthfirstaid.org/2021/06/how-mental-health-first-aid-can-help-reduce-stigma/
- ALGEE: how MHFA helps you respond in crisis and non-crisis situations. National Council for Mental Wellbeing. April 15, 2021. Accessed June 6, 2021. https://www.mentalhealthfirstaid.org/2021/04/algee-how-mhfa-helps-you-respond-in-crisis-and-non-crisis-situations/
- Types of mental health professionals. National Alliance on Mental Illness. Updated April 2020. Accessed June 6, 2021. https://www.nami.org/About-Mental-Illness/Treatments/Types-of-Mental-Health-Professionals
Bethany Montoya, RDH, is a practicing dental hygienist with nearly 10 years of clinical experience. She has advanced knowledge and training in complex cosmetic dentistry, sleep disordered breathing, TMJ disorders, and implant dentistry. She is highly experienced in productive hygiene and has achieved successes in hygiene diagnosis and acceptance that have far exceeded the industry standard. Over the course of her career, she has discovered a passion for leadership, building team culture, communication, and accountability. She has devoted her most recent years to focusing on the personal and relationship aspects of dentistry through her latest project, Human RDH. She can be reached at [email protected].